Provider Demographics
NPI:1063046308
Name:GEORGE J. SPADER, DDS, PC
Entity type:Organization
Organization Name:GEORGE J. SPADER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SPADER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-847-1780
Mailing Address - Street 1:7437 JACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9223
Mailing Address - Country:US
Mailing Address - Phone:734-847-1780
Mailing Address - Fax:734-847-2080
Practice Address - Street 1:7437 JACKMAN RD
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9223
Practice Address - Country:US
Practice Address - Phone:734-847-1780
Practice Address - Fax:734-847-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental